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Strengthen the Evidence for Maternal and Child Health Programs

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Items in this list may be obtained from the sources cited. Contact information reflects the most current data about the source that has been provided to the MCH Digital Library.


Displaying records 1 through 20 (75 total).

Peoples MD. n.d.. The role of maternity and infant care projects in reducing low weight births. Unpublished manuscript, 39 pp.

Annotation: This paper gives a historical overview of the Maternity and Infant Care (MIC) projects enabled through amendments to Title V of the Social Security Act in 1963. The paper presents available data on MIC project accomplishments, with particular emphasis on the relationship of the projects to the incidence of low birth weight. Topics include: the evolution of MIC projects; administration and financing; objectives of the projects; eligibility; coverage of women and infants at risk; quality of care; effects on the use of care and low birth weight; and cost. The difficulties in evaluating these projects is also discussed, including methodological problems and issues of interpretation. A list of references is provided. Tables with information on the projects and evaluations of these projects are provided at the end of the paper.

Keywords: Federal MCH programs, History, Low birthweight infants, Prenatal care, Prevention programs

Payne E, Garcia S, Minkovitz C, Grason H, Strobino D. 2017. Strengthen the evidence base for maternal and child health programs: NPM 3–Risk-appropriate perinatal care [NPM 3 brief]. Baltimore, MD: Johns Hopkins Bloomberg School of Public Health, Women's and Children's Health Policy Center, 3 pp.

Annotation: This brief identifies evidence-informed strategies that state Title V programs may consider implementing to increase the percentage of very low birth weight (<1500 gm) infants born in hospitals with a level III or higher neonatal intensive care unit. Contents include information about the methods and results of the evidence review, key findings, and implications. The full review is also available. [Funded by the Maternal and Child Health Bureau]

Contact: Johns Hopkins Bloomberg School of Public Health, Women's and Children's Health Policy Center, 615 North Wolfe Street, Room E4143, Baltimore, MD 21205, Telephone: (410) 502-5450 Fax: (410) 502-5831 Web Site: http://www.jhsph.edu/wchpc Available from the website.

Keywords: Block grants, Childbirth, Evidence-based practice, High risk pregnancy, Hospitals, Infant mortality, Intervention, Literature reviews, Low birthweight, Measures, Model programs, Neonatal intensive care units, Newborn infants, Perinatal care, Policy development, Program planning, Protective factors, Regional medical centers, Regional planning, Resources for professionals, State MCH programs, Systems development, Title V programs

Payne E, Garcia S, Minkovitz C, Grason H, Lai YH, Karp C, Strobino D. 2017. Strengthen the evidence for maternal and child health programs: National performance measure 3 risk-appropriate perinatal care evidence review. Baltimore, MD: Johns Hopkins Bloomberg School of Public Health, Women's and Children's Health Policy Center, 46 pp. (brief 3 pp.).

Annotation: This document identifies evidence-informed strategies that state Title V programs might consider implementing to increase the percentage of very low birth weight (<1500 gm) infants born in a hospital with a level III or higher neonatal intensive care unit. Contents include an introduction and background; review methods and results, including search results, characteristics of studies reviewed, intervention components, summary of study results, and evidence rating and evidence continuum; and implications of the review. [Funded by the Maternal and Child Health Bureau]

Contact: Johns Hopkins Bloomberg School of Public Health, Women's and Children's Health Policy Center, 615 North Wolfe Street, Room E4143, Baltimore, MD 21205, Telephone: (410) 502-5450 Fax: (410) 502-5831 Web Site: http://www.jhsph.edu/wchpc Available from the website.

Keywords: Block grants, Childbirth, Evidence-based practice, High risk pregnancy, Infant mortality, Intervention, Literature reviews, Low birthweight, Measures, Model programs, Neonatal intensive care units, Newborn infants, Perinatal care, Policy development, Program planning, Resources for professionals, State MCH programs, Title V programs

National Institute for Health Care Management Foundation. 2017. Giving more babies a healthy start in life: An Anthem Foundation & March of Dimes collaboration to reduce preterm births. Washington, DC: National Institute for Health Care Management Foundation, 4 pp.

Annotation: This fact sheet describes national and state initiatives to scale up and implement programs that encourage and facilitate first trimester prenatal care and help at-risk mothers commit to behaviors that reduce the numbers of low birthweight infants. Topics include a group prenatal care model called CenteringPregnancy®, smoking cessation programs, quality improvement initiatives related to the elimination of early elective deliveries, and Healthy Babies Are Worth the Wait Community Programs®.

Contact: National Institute for Health Care Management Foundation, 1225 19th Street, N.W., Suite 710, Washington, DC 20036, Telephone: (202) 296-4426 Fax: (202) 296-4319 E-mail: http://www.nihcm.org/contact Web Site: http://www.nihcm.org Available from the website.

Keywords: Childbirth, Collaboration, Community based programs, Community based services, Evidence based medicine, Financing, Health behavior, Health promotion, High risk infants, High risk mothers, High risk pregnancy, Low birthweight, Models, National initiatives, Peer support programs, Prenatal care, Preterm birth, Prevention programs, Smoking cessation

[Connecticut Coalition to Improve Birth Outcomes]. 2015. Connecticut plan to improve birth outcomes. [no place: Connecticut Coalition to Improve Birth Outcomes], 87 pp.

Annotation: This document provides recommendations and strategies for improving birth outcomes in Connecticut. Contents include the list of organizations represented on the Connecticut Coalition to Improve Birth Outcomes and how they used policy analysis tools to identify priorities and recommendations, and the Collaborative Improvement and Innovation Network that supports the strategies outlined in the plan. Topics include addressing socioeconomic factors, making the healthy choices the easy choice, protecting individuals, implementing evidence-based interventions in clinical settings, and providing individual or public educational messages and support. Information about the perinatal landscape, emerging issues, and suggestions for using the plan are also included.

Contact: Community Foundation of Greater New Haven, 70 Audubon Street, New Haven, CT 06510-9755, Telephone: (203) 777-2386 Fax: (203) 787-6584 E-mail: [email protected] Web Site: http://www.cfgnh.org Available from the website.

Keywords: Coalitions, Collaboration, Connecticut, Ethnic groups, Health disparities, Infant mortality, Infants, Low birthweight, Networking, Outcome and process assessment, Perinatal care, Pregnant women, Preterm birth, Program improvement, Service integration, Statewide planning, Systems development

Johns Hopkins Bloomberg School of Public Health, Women's and Children's Health Policy Center. 2015. Strengthen the evidence for MCH programs: Environmental scan of strategies National Performance Measure (NPM) #3: Perinatal regionalization. Baltimore, MD: Johns Hopkins Bloomberg School of Public Health, Women's and Children's Health Policy Center, 6 pp.

Annotation: This environmental scan identifies collections of strategies to advance performance for NPM #3: Perinatal Regionalization--percent of very low birth weight (VLBW) infants born in a hospital with a Level III+ neonatal intensive care unit (NICU). It includes a list of reviews and compilations on the topic; frameworks and landmark initiatives; databases and related search terms; and inclusion and exclusion criteria. [Funded by the Maternal and Child Health Bureau]

Contact: Johns Hopkins Bloomberg School of Public Health, Women's and Children's Health Policy Center, 615 North Wolfe Street, Room E4143, Baltimore, MD 21205, Telephone: (410) 502-5450 Fax: (410) 502-5831 Web Site: http://www.jhsph.edu/wchpc Available from the website.

Keywords: Block grants, Evidence-based practice, Hospitals, Literature reviews, Low birthweight infants, Measures, Model programs, Neonatal intensive care units, Perinatal care, Policy development, Program planning, Regional planning, Resources for professionals, State MCH programs, Title V programs

Klebanov PK. (2013). Variation in home visiting of the first three years of life: Links to family characteristics, aspects of home visits, and child outcomes. Princeton, NJ: Princeton University and Columbia University, 44 pp.

Annotation: This paper, which focuses on the Infant Health and Development Program, a randomized multisite study of 985 low-birthweight infants and their families, examines the following three questions: (1) What are the different patterns of home visits? (2) Which child, maternal, and family demographic characteristics and qualities of the home visit are associated with these home-visitation patterns? (3) Are higher frequency patterns of home visits associated with positive effects for children's cognitive and behavioral outcomes and mothers' depression, social support, and knowledge of child development? The authors also examine the significance of the home environment. The paper includes a literature review and a description of the study method, measures, data analysis, and results.

Contact: Pew Charitable Trusts, One Commerce Square, 2005 Market Street, Suite 1700, Philadelphia, PA 19103-7077, Telephone: (215) 575-9050 Fax: (215) 575-4939 E-mail: [email protected] Web Site: http://www.pewtrusts.org Available from the website.

Keywords: Behavior disorders, Behavior problems, Child behavior, Cognitive development, Depression, Early childhood development, Families, High risk groups, Home visiting, Infant development, Infants, Low birthweight infants, Low income groups, Mothers, Parent support programs, Postpartum depression, Programs, Young children

Figlio DN, Guryan J, Karbownik K, Roth J. 2013. The effects of poor neonatal health on children's cognitive development. Cambridge, MA: National Bureau of Economic Research, 55 pp. (NBER working paper series no. 18846)

Annotation: This paper discusses the results of a study on children born in Florida from 1992 to 2002, and the effect of birth weight on cognitive development from kindergarten through middle school. Study methodology is reviewed and results are discussed in the following categories: heavier versus lighter twins; testing; results by grade; differences by genetics, gender, maternal race, ethnicity and immigrant status; and family socioeconomic status. Topics also include birth weight discordance, school quality and the effect of birth weight on test scores, and birth weight gaps at kindergarten entry. A bibliography and statistical data conclude the paper.

Contact: National Bureau of Economic Research, 1050 Massachusetts Avenue, Cambridge, MA 02138-5398, Telephone: (617) 868-3900 Fax: (617) 868-2742 E-mail: [email protected] Web Site: http://www.nber.org Available from the website.

Keywords: Cognitive development, Florida, Learning, Low birthweight, Newborn infants, School readiness, State surveys, Statistical data, Young children

Linden DW, Paroli ET, Doron MW. 2010. Preemies: The essential guide for parents of premature babies. (2nd ed.). New York, NY: Pocket Books, 633 pp.

Annotation: This book is written for expecting or new parents of premature babies. It is divided into the following sections: before birth, in the hospital, a life together, and other considerations. Before birth outlines some known causes of premature labor and birth and how to prevent them. Topics discussed in the second part include the premature delivery, the neonatal intensive care unit at the hospital, testing and possible complications that occur in the first week, settling down in the hospital, and if baby needs surgery. Part three covers decisions and preparations for taking baby home, what to expect and watch for during early development and possible consequences of prematurity. Part four talks about losing a premature baby and ways of coping with grief and what special arrangements should be expected. Also discussed are examples of famous premature babies that thrived. The appendices include conversion charts, growth charts, a schedule for multiples, cardiopulmonary resuscitation - birth to one year, and resources. A glossary and an index conclude the text.

Contact: March of Dimes, 1275 Mamaroneck Avenue, White Plains, NY 10605, Telephone: (914) 997-4488 Secondary Telephone: Web Site: http://www.marchofdimes.com Available in libraries. Document Number: ISBN 0-671-03491-X.

Keywords: Consumer education materials, Infant death, Infant development, Infant health, Low birthweight, Neonatal intensive care units, Neonatal screening, Parent education, Pregnancy complications, Pregnancy outcome, Premature infant diseases, Premature infants, Premature labor, Preterm birth

Home Visiting Needs Assessment Workgroup. 2010. State of Oregon supplemental information request: Statewide needs assessment. Portland, OR: Oregon Department of Human Services, 66 pp.

Annotation: This report provides statewide data for Oregon in the following categories: premature birth, low-birthweight infants, infant mortality, poverty, crime, domestic violence, school dropout rates, substance abuse, unemployment, child maltreatment, and other indicators of at-risk prenatal, maternal, newborn, or child health. County-level data for the same categories is also provided, and information on the selection process of a unit of analysis is offered. The report also includes information about the quality and capacity of Oregon's existing home-visiting programs and the state's capacity for providing substance abuse treatment. A narrative summary of needs-assessment results concludes the report.

Contact: Oregon Department of Human Services, Maternal and Child Health Section, 800 N.E. Oregon Street, Suite 825, Portland, OR 97232, Telephone: (971) 673-0252 Secondary Telephone: (971) 673-0372 Fax: (971) 673-0240 E-mail: [email protected] Web Site: http://public.health.oregon.gov/PHD/Directory/Pages/program.aspx?pid=25 Available from the website.

Keywords: Child health, Child maltreatment, Crime, Domestic violence, High risk groups, Home visiting, Infant health, Infant mortality, Low birthweight infants, Needs assessment, Oregon Preterm birth, Poverty, Reproductive health, School dropouts, State programs, Statistical data, Substance abuse, Treatment, Unemployment, Women', s health

Freeman VA. 2010. Very low birth weight babies delivered at facilities for high-risk neonates: A review of Title V national performance measure 17–Final report. Chapel Hill, NC: University of North Carolina at Chapel Hill, Cecil G. Sheps Center for Health Services Research, 41 pp.

Annotation: This report examines state maternal and child health (MCH) Title V grantees' national performance measure number (NPM) 17 -- the percent of very low birthweight (VLBW) infants delivered at facilities for high-risk neonates. The author looks at trends in the rate of VLBW deliveries in the appropriate hospital over an 8-year period and examines information obtained from a review of state Title V applications/annual reports and follow-up conversations with MCH staff in a sample of states. The report includes information about state rates that have improved, worsened, or remained the same. [Funded by the Maternal and Child Health Bureau]

Contact: U.S. Maternal and Child Health Bureau, Health Resources and Services Administration, 5600 Fishers Lane, Rockville, MD 20857, Telephone: (301) 443-2170 Web Site: https://mchb.hrsa.gov Available from the website.

Keywords: Block grants, Evidence-based practice, High risk infants, Literature reviews, Low birthweight infants, Measures, Model programs, Neonatal intensive care, Newborn infants, Policy development, Program planning, Resources for professionals, State MCH programs, Title V programs

Stone C, Mueller L. 2009. Association between WIC enrollment during pregnancy and low birth weight outcomes in Connecticut. Hartford, CT: Connecticut Department of Public Health, 13 pp.

Annotation: This study evaluates the association between enrollment by pregnant women in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) and birth weight outcomes in the state of Connecticut. The study is based on data collected from singleton birth records in the state and corresponding records among women enrolled in the state's HUSKY A public insurance program. The report presents data on nine risk factors for low birth weight controlled in the research model: Race/ethnicity, maternal age, education level, marital status, parity, previous lost pregnancy, prenatal care initiation, maternal medical risk factors, and tobacco use during pregnancy. The results -- reported in the form of birth weight outcomes -- are based on the enrollment of pregnant women at least 12 weeks prior to giving birth.

Contact: Connecticut Department of Public Health, 410 Capitol Avenue, Hartford, CT 06134-0308, Telephone: (860) 509-8000 E-mail: [email protected] Web Site: http://www.ct.gov/dph Available from the website.

Keywords: Connecticut, Low birthweight infants, Pregnancy outcome, Pregnant women, Public health programs, Research, State programs, WIC Program

Hallsworth M, Farrands A, Oortwijn WJ, Hatziandreu E. 2008. The provision of neonatal services: Data for international comparisons. Santa Monica, CA: Rand, 157 pp. (Technical report)

Annotation: This report presents a comparative analysis of neonatal services, followed by chapters on specific countries (Scotland, Wales, Northern Ireland, the United States, Canada, Sweden, and Australia). The information is divided into five categories: (1) trend in high-risk births and associated outcomes, (2) organization and scale of neonatal services, (3) neonatal transport services, (4) costs of neonatal services, and (5) best practices for infants and their families. The main purpose of the report is to provide a compendium of relevant data to facilitate comparisons and benchmarking of neonatal services in England with those of these other countries. Statistical information is presented in figures and tables throughout the report. References are included. The report includes two appendices: (1) methodology and (2) list of search terms used for literature review.

Contact: Rand Corporation, 1776 Main Street, Santa Monica, CA 90407-3208, Telephone: (310) 393-0411 Fax: 310-393-4818 E-mail: [email protected] Web Site: http://www.rand.org Available from the website.

Keywords: Costs, Families, Health care services, Infant health, International health, Low birthweight infants, Neonatal intensive care, Neonatal morbidity, Neonatal mortality, Trends

Foundation for Child Development Child and Youth Well-Being Index (CWI) Project. 2008. 2008 special focus report: Trends in infancy/early childhood and middle childhood well-being, 1994-2006. [New York, NY]: Foundation for Child Development , 32 pp.

Annotation: This focus report complements an annual update on trends in the overall quality of life for U.S. children and adolescents issued by the Foundation for Child Development and Youth Well-Being Index Project. The present report focuses on trends in indicators of well-being for two infant and child age groups -- birth through age 5 and 6-11 -- and makes comparisons with corresponding trends for adolescents ages 12-17 over the period 1994-2006. The report covers four main topics: (1) trends in age-specific composite well-being indices, (2) trends in domain-specific composite indices for childhood ages, (3) positive trends in specific indicators, and (4) areas of concern for specific indicators.

Contact: Foundation for Child Development, 295 Madison Avenue, 40th Floor, New York, NY 10017, Telephone: (212) 867-5777 Fax: (212) 867-5844 E-mail: [email protected] Web Site: http://www.fcd-us.org Available from the website.

Keywords: Adolescent health, Adolescents, Child health, Child mortality, Children, Education, Family income, Infant health, Infant mortality, Infants, Lead poisoning, Low birthweight, Motor vehicle safety, Nutrition, Obesity, Pregnancy, Prenatal care, Safety, Trends, Vaccination

Colorado Department of Public Health and Environment, Womne's Health Unit. 2008. Prenatal Plus provider manual. [Rev. ed.]. [Denver, CO]: Colorado Department of Public Health and Environment, ca. 75 pp.

Annotation: This manual presents information for service providers in the Prenatal Plus program, the goal of which is to improve birth outcomes by reducing the prevalence of low-birthweight infants among Medicaid-eligible women in Colorado. The manual provides a program overview and discusses team member roles, the client chart, client-centered counseling, referrals, provider requirements, quality assurance, data collection and submission, and billing.

Contact: Colorado Department of Public Health and Environment, 4300 Cherry Creek Drive, South, Denver, CO 80246, Telephone: (303) 692-2000 Secondary Telephone: (800) 886-7689 E-mail: [email protected] Web Site: https://cdphe.colorado.gov Available from the website.

Keywords: Referrals, Counseling, Colorado, Low birthweight infants, Low income groups, Manuals, Medicaid, Pregnant women, Prenatal care, Prevention, State programs

Center for Health Care Strategies. 2007. Collaborating to improve birth outcomes in New Jersey: A CHCS Project spotlight. [Hamilton, NJ]: Center for Health Care Strategies, 3 pp.

Annotation: This report profiles the experiences of the Center for Health Care Strategies initiative, New Jersey Collaborative to Improve Birth Outcomes and Health Status of Children. The report discusses (1) how the five New Jersey Medicaid plans worked collaboratively to standardize quality improvement (i.e., improve birth outcomes), (2) designing a standardized prenatal risk-assessment form (PRA), (3) getting buy-in from health professionals for the PRA, (4) managing a centralized data repository, (5) key lessons from the improving birth outcomes collaborative, and (6) moving forward.

Contact: Center for Health Care Strategies, 200 American Metro Boulevard, Suite 119, Hamilton, NJ 08619, Telephone: (609) 528-8400 Fax: (609) 586-3679 Web Site: http://www.chcs.org Available from the website.

Keywords: Infant health, Infant mortality, Initiatives: Collaboration, Low birthweight infants, Medicaid, New Jersey, Premature infants, Prenatal care, Prevention programs, State programs

Stephens KU. [2006]. Great Expectations New Orleans Healthy Start: Final impact report. New Orleans, LA: Great Expectations Foundation, 73 pp.

Annotation: This report describes the Great Expectations Foundation program implementation of a Healthy Start Family Resource model, a research and demonstration program based in New Orleans, serving neighborhoods characterized by extreme poverty, low educational levels, high rates of adolescent pregnancies, high dropout rates, and concentrated areas of public housing. The project period was 2001-2004.Topics include the prevalence of adolescent pregnancy; elevated infant mortality rates and the risk factors that correlate with elevated infant mortality rates such as low birthweight; and increasing service coordination between agencies and physically locating them in the same building or very near other community-based providers. Report contents include an introduction providing background on the program and site; a description of service initiation; a review of service accomplishments; an outline of program mentoring, consortium and collaboration development; a summary of the consortium program impact; and other Healthy Start components. Appendices include local evaluation findings and data tables used in the project. A CD-ROM is included. [Funded by the Maternal and Child Health Bureau]

Contact: Maternal and Child Health Library at Georgetown University, E-mail: [email protected] Web Site: https://www.mchlibrary.org

Keywords: Adolescent pregnancy, Case studies, Community coordination, Final reports, Healthy Start, Infant mortality, Intervention, Local MCH programs, Louisiana, Low birthweight infants, Model programs, Prevention programs, Program descriptions, Program evaluation, Service coordination

Ratney RR. 2006. Northwest Indiana Healthy Start: Impact Summary. Hammond, IN: Northwest Indiana Healthy Start, 45 pp., plus appendices.

Annotation: This final report focuses on the Northwest Indiana Healthy Start project during the period February 1, 2002, through January 31, 2006. The project provided comprehensive prenatal care services to a population with high rates of low-birthweight infants and infant mortality. Report sections include (1) overview, (2) project implementation, (3) project management and governance, (4) project accomplishments, (5) project impact, (6) local evaluation, (7) fetal infant mortality review, (8) products, (9) project data, and (10) implementation plan. Also included are a variety of consumer-education materials, some of which are written in Spanish. [Funded by the Maternal and Child Health Bureau]

Contact: Maternal and Child Health Library at Georgetown University, E-mail: [email protected] Web Site: https://www.mchlibrary.org Available from the website.

Keywords: Final reports, Healthy Start, Indiana, Infant mortality, Low birthweight infants, Poverty, Pregnant women, Prenatal care, Prevention programs, Spanish language materials

Boykins CY. 2005. The Atlanta Healthy Start Initiative: Impact report 1998-2001. Atlanta, GA: Center for Black Women's Wellness, 51 pp., plus appendices.

Annotation: This report describes a Healthy Start program in Atlanta, Georgia, from 2001-2005 committed to improving the health and well-being of black women and their families, particularly to address the racial and ethnic disparities between black and white women in perinatal health outcomes, infant mortality, low birthweight, and adolescent birth rates. Content of the report include an overview of racial and ethnic disparities focused on by the project; project implementation, management and governance, and accomplishments; and the impact of the project on systems of care, the community, the state, and the role of local government. Also included is a copy of the local evaluation report, and fetal and infant mortality review involvement. Appendices include products produced during the project as well as required data and service tables and forms. [Funded by the Maternal and Child Health Bureau]

Contact: Maternal and Child Health Library at Georgetown University, E-mail: [email protected] Web Site: https://www.mchlibrary.org

Keywords: Access to health care, Adolescent pregnancy, Blacks, Final reports, Georgia, Healthy Start, Infant mortality, Infant mortality, Low birthweight infants, MCH services, Perinatal health, Prevention programs, Women', s health

Townsend KL. 2005. Visiting Nurse Services Des Moines Healthy Start Program: Impact report. Des Moines, IA: Visiting Nurse Services, Des Moines Healthy Start Program, 62 pp., plus appendices.

Annotation: This impact final report describes a Healthy Start program to provide services for participants identified as "high-risk" for poor perinatal (maternal and child) outcomes in Des Moines, Iowa. The impact report covers the period June 2001 through May 2005. Report contents include an overview of racial and ethnic disparity focused on by the project, the implementation of the project, management and governance, and project accomplishments. Also reported are impacts on local systems of care, the community, the state, and the role of local government. Additional sections provide information on fetal and infant mortality review, samples of products developed during the project, and project data provided in table format. Appendices include the project area map, a best practices manual that describes policies and procedures, bylaws on the consortium and steering and sustainability committee, and project data. Additional attachments include project accomplishments, goals, objectives and strategies; a copy of the local evaluation report; a progress report for case managers on depression counseling; and more sample products. [Funded by the Maternal and Child Health Bureau]

Contact: Maternal and Child Health Library at Georgetown University, E-mail: [email protected] Web Site: https://www.mchlibrary.org Available from the website.

Keywords: Children with special health care needs, Community programs, Final reports, Healthy Start, Immunization, Infant mortality, Iowa, Local MCH programs, Low birthweight infants, Low income groups, Prenatal care, Prevention programs, Smoking during pregnancy

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This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U02MC31613, MCH Advanced Education Policy, $3.5 M. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.